Is Locum Work For Me?
Many CRNAs consider locum work. As someone who has ventured down this path, allow me to share some considerations so you can determine if locum work is for you.
Full-Time Locum vs Spot Coverage Locum
Locums doesn’t need to be all-or-nothing. There are plenty of options out there. I’ll approach both ends.
Full-Time Locum work is awesome but comes with plenty of drawbacks. I’ll discuss these in the following considerations.
Spot coverage locum work is for those who have a non-locum full-time job and just work locums on time off. Think PTO weeks or free weekends. Agencies typically want 3 weeks per year to recover their costs. Spot coverage is a good way to go for a few reasons.
You have a full-time job, so job security is reasonably strong.
You have benefits. Most CRNAs are W-2, which includes benefits, so your 1099 work is done as a sole proprietor. Really easy on the books.
You don’t have the typical locum headache points. Or at least not as many.
You can still earn $10,000 per week as a locum. Really nice boost to pay off loans, pay for a vacation, or build an investment portfolio.
Financial Considerations
It comes without saying, but locums have the opportunity to make bank. Like, serious bank. In a post, Locum CRNA: Financially Independent in 5 Years, I break down the range of common locum incomes. And yes, how a locum CRNA can earn enough in 5 years to achieve FI status.
On the low end, $322,000 annually. This is a job without nights, weekends, or call. Could be done working 26 weeks.
On the high end, basically as much as you want, but I figured $621,000 annually as still being reasonable to attain.
The compensation spread between full-time jobs and locum jobs is significant. This is for good reason. The consideration is this…If you find yourself with income being a problem, locum work is for you.
Willingness to Travel
If you live in an area ripe with locum opportunities, that’s great (and not so great at the same time). It’s common to travel for locum work. Are you willing to travel via plane, train, or automobile to optimize your locum job search?
Assume you sign a 13-week contract requiring relocation. You must bring everything you need for the duration. This assignment may include a flight and rental car.
What are your housing options? Short-term rental, hotel, or RV? The flowchart for solutions is endless.
The TFC family often travels together. We prefer short-term rentals for the kitchen setup and the ability to prepare meals. Frequently dining out becomes expensive and loses appeal after a short while. We utilize hotels for weekend coverage.
We developed a system for frequent relocations with the use of totes and duffle bags. Pack everything Friday to leave after work. Unload everything Sunday evening for the week ahead.
I know locums that remain local. Something like a daily 60-minute commute. Better for family life, but you have unpaid hours during the commute. Sleep in your own bed at night.
The drawback is contract instability. If the hospital finds someone cheaper, you will be out of locum work.
Personal Life
Consider these personal life considerations:
Do you have a family?
Will they travel too?
Kids in school?
Pets at home?
Does your spouse have a job?
The answers determine if you can locum full-time on a national scale, full-time on a local scale, during PTO weeks, or not at all.
We have a nationwide radius. To do this, Mrs. TFC no longer works. This allows us the required flexibility. Little Miss TFC is not in school yet. Common solutions include locum until school age or homeschool.
The current trajectory has us on the road for a few more years, then forgoing nationwide availability in favor of family life. The idea is to have achieved financial independence by that point. We would need an investment portfolio of nearly $2.5M. Such status would make income irrelevant.
Bold assumption for FI by 35? Not really. I went as far as creating an online course to follow the same financial path.
Logistical Issues
Full-time locums almost always benefit from establishing an LLC. This is intimidating, but it really isn’t that bad. I have a post explaining the upfront work. It is a short entry about LLC setup, EIN, business bank accounts, and insurance. Read it here: 1099: 13 Easy Steps to Get Started.
To minimize headaches, I’m noting the appeal to signing a 6 or 12-month contract. It’s fewer contracts to sign, less credentialing, and fewer travel arrangements to book. Fewer hospitals to learn and agencies to work with.
Long contract present their own issues such as premature termination. Most contracts have a 30-day out. This presents and issue if this is your only location. It’s ideal to have a backup location, but if you focus all work hours at a single facility, your credentials at other locations may expire.
Contract negotiations are the worst and have quite frankly made me cynical. I always miss something and it rarely works in my favor. My experiences have led me to become that annoying guy that not only negotiates rates, but also requests verbiage changes and specifics. If it isn’t in the contract, it doesn’t exist. And my legal team can’t compete with that of an agency or hospital.
The last pain is taxes. I work in different states. All of which have their own requirements. All of which I file as a foreign entity. It’s a matter of making phone calls to state agencies for clarification and sending checks all over the place.
A Certified Public Accountant (CPA) is a great member to add to the team. It remains a requirement to self-educate because your CPA doesn’t know everything. You are responsible for vetting and asking respectable questions to ensure competency.
Your Experience
Your experience dictates which jobs you can take. The major checkboxes are as follows:
Hearts
Heads
Critical Peds
OB
Regional Anesthesia
Lines
I’m a rural practitioner. Blocks, lines, and OB…not a problem. I’d need a refresher before taking a heart. To work at a major academic center, I would include verbiage in the contract stating, “no hearts.”
Personally, the only pay difference I have noted is for cardiac CRNAs. There isn’t a pay increase for anything else. Yeah, pretty disheartening, but the facilities generally don’t care. They will just dictate assignments based on scope of practice.
Other checkboxes include:
ACT
Supervision
Independent/Solo
Mandatory Call
Weekends
These checkboxes are criteria to determine if a job is of interest. I sort jobs by practice model. I also look for weekends and call. I’m trying to make the most of my locum years.
Regarding the day-to-day, I haven’t run into trouble at any of the 5 facilities I have covered. Staff is generally happy to see you because additional staff decreases their workload. Less mandatory call. And perm staff is first to leave for the day, so their weekday shifts are lighter.
In theory, there could be resentment knowing locums are paid a higher rate for doing the same job; however, locums are away from home, working in unfamiliar areas, and carry a number of logistical pains. I have only had positive experiences with perm staff.
Agencies and Recruiters
Your recruiter doesn’t know you. You are just a number and paycheck for the agency. Don’t expect any favors. They aren’t liable if you take an assignment you are uncomfortable with. Business is business.
Recruiters play by a different standard. If I chart inaccurately, that’s fraud. If a recruiter lies about an assignment and gets call out, nothing happens. Don’t trust a recruiter. I have worked with good and not-so-good recruiters.
Try to find an honest person to work with. Remember, your license is yours to protect.
New Grads
So…can a new grad locum? Technically yes, but not where I work. I don’t recommend it because you don’t know what you don’t know. This section follows agencies and recruiters because a recruiter may say you qualify for an assignment, even if the assignment would place you in an uncomfortable or litigious situation. All CRNAs hold the same licensure, but not the same comfort level or skillset.
It’s awesome to have a big paycheck right out of school. But…as a locum, places expect a lot in return for that paycheck. They expect you to show up and perform without any orientation. Seriously, solo call with a 15-minute orientation just to show you the locker room, ORs, and OB.
No teaching of spinals, epidurals, lines, or blocks. No explaining what’s in the kits. No rundown of supplies, drugs, or equipment.
I don’t know any new grads, including myself, that could have managed this type of practice without a couple months as a CRNA.
The only route for a new grad locum would be at a former clinical site. Somewhere you know the equipment, workflow, and staff. And preferably in a non-call position, so you may have a free set of hands during the day if something exciting happens.
For as much as I have enjoyed locum work, I recommend even a short duration as full-time staff to hone your skills. If you have failed blocks or can’t consistently place epidurals, it won’t go well for you. There isn’t anyone to provide feedback.
Consider the practice type and requirements before committing.
Job Market
The current market allows for great flexibility. There will always be locum opportunities available. The selection of locum opportunities is what will change. The “tough to staff” and “undesirable locations” will always exist. There will always be contract changes somewhere needing interim staff.
W-2, 1099, and locum CRNA work all have their advantages and disadvantages. Use this entry as a consideration checklist.
Locum work isn’t for everyone. I have found locum work to be rewarding. Compensation is solid. Travel gets old. Taxes become more complicated. Overall work experience has been good.
As a young CRNA, compensation is disproportionally prioritized. With the removal of the pension, the financial benefits for loyalty are negated.
In the coming years, my priorities will change. Location or work-life balance may top the list. A permanent job may fit that criteria better than locum work.
Fortunately, if you try a different route and decide it isn’t for you, there will likely be a way out. Thanks for reading!
